Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT
but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.

Personal Information

First Name

Middle Name

Last Name

Home Phone

Work Phone

Cell Phone

Email Address

Addresses

Current Address 1

Street

Street

City

City

State

State

Zip Code

Zip Code

Since (Mo/Yr)

Since (Mo/Yr)

To (Mo/Yr)

Prior Address

Street

City

State

Zip Code

Since (Mo/Yr)

To (Mo/Yr)

Prior Address

Street

City

State

Zip Code

Since (Mo/Yr)

To (Mo/Yr)

Education

School Attended

City

State

Diploma

Degree/Cert.

Area of Study

High School

High School

School Attended

City

State

Diploma

No
Yes

GED

Undergrad School

Undergrad School

School Attended

City

State

Diploma

No
Yes

Degree/Cert.

Area of Study

Grad School

Grad School

School Attended

City

State

Diploma

No
Yes

Degree/Cert.

Area of Study

Other School

Other School

School Attended

City

State

Diploma

No
Yes

Degree/Cert.

Area of Study

Employment Information

Position Applied For

Date You Can Start (yyy-mm-dd)

Desired Salary $

Do You Prefer

Can you work
Weekends Evenings

Available
M Tu W Th F Sa Su

Are you available for shift work?

No
Yes

Not Available

Please answer all of the following questions.

1.

Are you at least 18 years of age and legally eligible to work for our company in the United States?

No
Yes

If you are under 18 years of age, can you provide required proof of your eligibility to work?

No
Yes

2.

Have you worked for this business before?

No
Yes

If yes, please provide dates and locations.

3.

Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?

No
Yes

4.

Do you understand the job requirements?

No
Yes

If no, please explain.

5.

Are you on layoff and subject to recall?

No
Yes

6.

Are you currently bound by a noncompetition, confidentiality or trade secret agreement?

No
Yes

If yes, please explain...

7.

Have you ever been discharged or asked to resign from a job?

No
Yes

If yes, please explain...

8.

Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?

No
Yes

If yes, please explain...

9.

Do any of your friends or relatives, other than spouse, work here?

No
Yes

If yes, state name and relationship...

Employment History

Are you currently employed?

No
Yes

May we contact your present employer?

No
Yes

Most Recent Employer

Employer

Employer

City

City

State

State

Zip Code

Zip Code

Phone

Phone

Position Held

Position Held

From (m/yyyy)

From (m/yyyy)

To (m/yyyy)

To (m/yyyy)

Pay upon leaving

Pay upon leaving

Supervisor

Supervisor

Duties

Duties

Reason for Leaving

Reason for Leaving

Prior Employer 1

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Prior Employer 2

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Prior Employer 3

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Job-related Skills

Please answer the following questions if the position you are applying for requires driving a motor vehicle

1.

Do you have a valid driver's license?

No
Yes

If yes, Driver's License Number

Date of Issue

2.

Have you been convicted of or pled guilty to any traffic-related offense within the past five years?

No
Yes

If yes, please explain...

3.

Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?

No
Yes

If yes, please explain...

4.

Please list all states from which you hold or held a driver's license

5.

Please use this space to list any special skills you may have that relate to the position applied for

6.

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.

The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.

2.

The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.

3.

If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.

4.

Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ.

5.

I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

6.

I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.

Name (first and last)*Address*City*State*Zip Code*Email*Telephone*Validate

Thank you for submitting a Roofing Estimate form. Someone from Midwest Roofing Services will be contacting you using the information you provided within the next business day. If you have any questions or problems or need more rapid attention, you may call us at 800-678-7815, or 316-262-4758.

Credentials: Midwest Roofing Services has partnered with the top manufacturers in the industry. Midwest Roofing has been awarded the prestigious certification of Master Select by the largest roofing manufacturer in North America, “GAF Materials Corp.”. This certification is reserved for the Top 2% of the roofing contractors nation wide. Midwest Roofing is also certified applicators for the following manufacturers. Versico Roofing Systems, Certainteed Commercial Roofing and Topps Products, Inc. This partnership allows us to provide the following types of roofing applications with extended manufacturers warrantees. Thermoplastic (PVC and TPO), Thermoplastic Fleece Back, Epdm, Modified Bitumen, Built up Roofing, Roof Coatings, Metal Roof Restorations.

Midwest Roofing Services is a Wichita, Kansas based residential and commercial roofing company, founded in 1955, with a service area that includes: Arkansas, Colorado, Kansas, Missouri, Nebraska, Oklahoma and Texas